Healthcare providers, such as pharmacies, physicians, and/or hospitals, often generate healthcare transactions, such as healthcare claim transactions, that are communicated, to appropriate claims processors or payors, such as insurance providers or government payors, for approval. In order to ensure compliance with the Health Insurance Portability and Accountability Act (“HIPAA”), healthcare providers often desire to include only necessary or required data when preparing a healthcare transaction to be communicated to a payor. Each payor typically has a proprietary mixture of data fields required to be populated by a healthcare provider when a healthcare transaction is communicated to the payor.
Payors typically publish information associated with required data fields in respective payor sheets. However, payors often fail to update or maintain their payor sheets in a timely manner. Accordingly, as new data fields are required and/or other data fields are no longer required, the published payor sheets may become outdated and a healthcare provider may not be able to readily ascertain the information that is required to be included in a healthcare transaction. Additionally, when a healthcare provider purchases and/or installs a new practice management system, the healthcare provider is often required to start from scratch in building one or more plan setups. In other words, the healthcare provider typically has to engage in a time consuming process to generate forms that can be populated by employees when preparing healthcare transactions.
Therefore, systems and methods for generating and/or updating payor sheets are desirable.